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SPONTANEOUS PNEUMOTHORAX
Category: Pediatric Surgery
Abstract : Spontaneous Pneumothorax : Most pneumothorax in children are the result of blunt/open chest trauma, mechanical ventilation (barotrauma), bronchial asthma or an infectious pulmonary process. Primary spontaneous pneumothorax (PSP) is rare in children with most cases seen in adolescent males with thin body habitus. Main presenting symptoms consist of chest pain, cough and shortness of breath. Recurre
Spontaneous Pneumothorax : Most pneumothorax in children are the result of blunt/open chest trauma, mechanical ventilation (barotrauma), bronchial asthma or an infectious pulmonary process. Primary spontaneous pneumothorax (PSP) is rare in children with most cases seen in adolescent males with thin body habitus. Main presenting symptoms consist of chest pain, cough and shortness of breath. Recurrence is high in this older population of children.
PSP is usually the result of: 1) a ruptured apical bleb or bullae in three-fourth cases, 2) destructive parenchymal disease (cystic fibrosis, AIDS), or 3) alveolar rupture due to proximal airway obstruction. Initial management consists of oxygen supplementation for small pneumothorax less than 15% with no tension physiology present. Chest tube drainage is needed for medium or large size pneumothorax. Recurrence or persistent pneumothorax is managed with video-assisted thoracoscopic surgery (VATS) by ablating with endoscopic stapling (Endo GIA), suturing or ligating using an endoloop technique the apical bullae followed by pleurodesis. Pleurodesis can be done chemically or surgically. Chemical pleurodesis is achieved with such agents as talc, tetracycline, bleomycin or quinacrine instillation. Mechanical pleurodesis carries a lower recurrent rate and can be achieved by abrasion or electrocoagulation. Most common complication is persistent air leak. VATS is a fast, cost-effective method of treatment for PSP with less morbidity.
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